Thyroidectomy

What is Thyroidectomy

Thyroidectomy is a surgery that is done to remove the thyroid gland. The thyroid is a butterfly-shaped gland that is located at the lower front of your neck. It produces thyroid hormone, which is a substance that helps to control certain body processes. You may have a:

• Total thyroidectomy. All of your thyroid is removed.
• Thyroid lobectomy. Part of your thyroid is removed.

The amount of thyroid gland tissue that is removed during your surgery depends on the reason for the procedure. Reasons to have this procedure include treatment for:

• Thyroid nodules.
• Thyroid cancer.
• Benign thyroid tumors.
• Goiter.
• Overactive thyroid gland (hyperthyroidism).

There are two ways to do this procedure. Conventional, or open, thyroidectomy uses one large incision to remove the thyroid gland. This is the most common method. Endoscopic thyroidectomy, a less invasive method, uses a narrow tube with a light and camera (endoscope) to remove the gland.

Total, near-total, and subtotal thyroidectomies

A total thyroidectomy removes all grossly visible thyroid tissue. A near-total thyroidectomy removes all grossly visible thyroid tissue except for a small amount (< 1 g) adjacent to where the recurrent laryngeal nerve enters the larynx.

Total and near-total thyroidectomies have equivalent oncologic outcomes and are often considered synonymous.

A subtotal thyroidectomy leaves more than 1 g of thyroid tissue and is not an appropriate cancer operation.

It is used occasionally in patients with benign multinodular goiter or hyperthyroidism in an attempt to leave enough thyroid hormone so that replacement is not required.

However, subtotal thyroidectomy for hyperthyroidism significantly increases the risk of recurrent hyperthyroidism (8%) compared with near-total/total thyroidectomy (0%) and is generally not recommended.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Damage to the parathyroid glands. These are located behind your thyroid gland. They maintain the calcium levels in the body. Damage may lead to:
  • A decrease in parathyroid hormone levels (hypoparathyroidism).
  • A decrease in calcium levels. This will make your nerves irritable and may cause muscle spasms.
• An increase in thyroid hormone.
• Damage to the nerves of your voice box (larynx). This can be temporary or long-term (rare).
• Hoarseness. This usually resolves in 24–48 hours.
• Bleeding.
• Infection.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• You may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Your health care provider will perform your surgery using one of two methods:
  • For open thyroidectomy, an incision will be made in your lower neck. Muscles in the area will be separated to reveal your thyroid gland.
  • For endoscopic thyroidectomy, several small incisions will be made in your neck, chest, or armpit. An endoscopewill be inserted into an incision.
• Your health care provider may monitor laryngeal nerve function during the procedure for safety reasons.
• Part or all of your thyroid gland will be removed.
• A tube (drain) may be placed at the incision site to drain blood and fluids that accumulate under the skin after the procedure. The drain may have to stay in place for a day or two after the procedure.
• The incision will be closed with stitches (sutures).
• A dressing will be placed over your incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• Your provider will check your ability to talk and swallow after the procedure.
• You will gradually start to drink liquids and have soft foods as tolerated.
• You may have a blood test to check the level of calcium in your body.
• If you had a drain put in during the procedure, it will usually be removed the next day.

What is the appropriate extent of thyroidectomy for differentiated thyroid carcinoma?

For differentiated (papillary, follicular, Hürthle cell) cancers, the extent of surgery is determined by tumor size, history of radiation, family history, and clinical evidence of metastases.

For low-risk microcarcinomas (< 1 cm, no invasion or evidence of nodal/distant metastasis), active surveillance may be considered; otherwise, a thyroid lobectomy should be performed unless there is a clear indication to remove the contralateral lobe.

Until recently, total or near-total thyroidectomy was recommended for all tumors > 1 cm; however, multiple studies have found that in properly selected low- to intermediate-risk patients, thyroid lobectomy and thyroidectomy have equivalent outcomes.

Therefore, the most current guidelines state that the initial surgical procedure for unifocal tumors 1 to 4 cm in size without extrathyroidal extension and without nodal/distant metastases can be either thyroidectomy or thyroid lobectomy.

Factors which might lead to thyroidectomy being chosen over lobectomy include older age (> 45 years), contralateral nodules (> 5 mm), history of radiation exposure, family history of thyroid cancer, or potential need for radioactive iodine.

For high-risk tumors (> 4 cm, gross invasion, clinically apparent nodal/distant metastases) a thyroidectomy is indicated.

Summary

• A thyroidectomy is a surgery that is done to remove the thyroid gland.
• The procedure will be done in one of two ways: conventional, or open, thyroidectomy or endoscopic thyroidectomy.
• Serious complications are rare.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

Thyroidectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Mild pain in the neck or upper body, especially when swallowing.
• A swollen neck.
• A sore throat.
• A weak or hoarse voice.
• Slight tingling or numbness around your mouth, or in your fingers or toes. This may last for a day or two after surgery. This condition is caused by low levels of calcium. You may be given calcium supplements to treat it.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not take medicines that contain aspirin and ibuprofen until your health care provider says that you can. These medicines can increase your risk of bleeding.
• Take a thyroid hormone medicine as recommended by your health care provider. You will have to take this medicine for the rest of your life if your entire thyroid was removed.

Eating and drinking

• Start slowly with eating. You may need to have only liquids and soft foods for a few days or as directed by your health care provider.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider approves.

Activity

• For the first 10 days after the procedure or as instructed by your health care provider:
  • Do not lift anything that is heavier than 10 lb (4.5 kg).
  • Do not jog, swim, or do other strenuous exercises.
  • Do not play contact sports.
• Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. This is needed to improve blood flow and breathing. Ask for help if you feel weak or unsteady.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing after surgery. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important. Your health care provider needs to monitor the calcium level in your blood to make sure that it does not become low.

Contact a health care provider if you:

• Have a fever.
• Have more redness, swelling, or pain around your incision area.
• Have fluid or blood coming from your incision area.
• Notice that your incision area feels warm to the touch.
• Have pus or a bad smell coming from your incision area.
• Have trouble talking.
• Have nausea or vomiting for more than 2 days.

Get help right away if you:

• Have trouble breathing.
• Have trouble swallowing.
• Develop a rash.
• Develop a cough that gets worse.
• Notice that your speech changes, or you have hoarseness that gets worse.
• Develop numbness, tingling, or muscle spasms in the arms, hands, feet, or face.

Summary

• After the procedure, it is common to feel mild pain in the neck or upper body, especially when swallowing.
• Take medicines as told by your health care provider. These include pain medicines and thyroid hormones, if required.
• Follow instructions from your health care provider about how to take care of your incision. Watch for signs of infection.
• Keep all follow-up visits as told by your health care provider. This is important. Your health care provider needs to monitor the calcium level in your blood to make sure that it does not become low.
• Get help right away if you develop difficulty breathing, or numbness, tingling, or muscle spasms in the arms, hands, feet, or face.